Document Sample
					                                                                          COMMUNITY DEVELOPMENT
                                                                              BLOCK GRANT (CDBG)
                                                                             FUNDING APPLICATION

                                         FY 2011-2012 SUMMARY CHART
                                          PLEASE TYPE YOUR APPLICATION

                                            APPLICANT INFORMATION
 Organization Name:
 Address (including City, State, Zip):
 Director’s Name:                                        Phone:                                Fax:

 Director’s Title:                                       E-Mail Address:

 Tax I. D. Number:                                       Agency Website:

                            PROJECT DESCRIPTION AND BUDGET
 1. Project Name/Description:

 2. Project Manager:
 3. Proposed Project Location:
 4. Total CDBG Funding Requested:
 5. Percentage (%) of Total Project Cost:
 6. Cost Per Client for Project:
 7. Percentage of Clients from McKinney who are Low to Moderate Income: ___ %
 8. Abbreviated Project Budget:
 9. Which National Objective Meets Your Proposed Project?
       Benefit Low/Moderate Income Persons/Households            Prevention of Slums/Blight
       Urgent Need
 10. Indicate the Priority Need that Best Identifies Your Project:
     Clothing                       Rent/Mortgage, Utility Assistance (Homeless Prevention)
     Food                           Housing
     Shelter                         Homeless Shelter/Transitional Housing
     Preventive Health               Neighborhood Revitalization
     Public Facility                Other:
     Youth Services

There is no guarantee, expressed or implied that funds will be provided to the applicant. The applicant agrees to
comply with all Federal and City policies and requirements affecting the CDBG program. The signatory declares
that he/she is an official of the application, is authorized to make this application, and certifies that the information
in this application is true and correct, to the best of his/her knowledge.

Authorized Official’s Name (type or print):

By: ___________________________________________
           Official’s Signature                                                        Date

      3/2011v.                                                                                                         1
                                CITY OF MCKINNEY
                       FUNDING APPLICATION FOR FY 2011 - 2012

1.    Activity Eligibility:

      Consolidated Plan Goals: Select the Best Strategy that fits the Proposed Project.

           Strategy 1. Improve the condition of housing occupied by the city’s lowest income
           homeowners and preserve affordable housing

           Strategy 2: Support organizations that assist the city’s special needs populations

           Strategy 3: Provide supportive services for those who encounter homeless or have a
           need for homeless prevention services.

           Strategy 4. Increase homeownership opportunities for low and moderate income

      Do you currently have a contract with the City for CDBG,
      Community Support Grant (CSG) or any other City funds?                     Yes       No

      List type and amounts for each:

      Are all taxes paid and up to date?                                         Yes       No

      Is the agency in good standing with the State of Texas?                    Yes      No

      Is the agency/organization’s Board of Directors in compliance
      with IRS Section (c) (3) certification?                                    Yes       No

      Before April 4, 2011, the agency has been in operation since 19______. (Fill in blank).

2.    Description of Grant Request (Max. 1 Page Response):
      Describe the activities to be carried out through this grant request, including the population
      to be served and the number of persons to be served. The description should define the full
      details of the activity (who, what, where and how). It should specifically describe and
      quantify the services or products to be provided as a result of the expenditure of CDBG
      funds, and how these services will be delivered. Where appropriate, specify how the project
      will ensure that the intended beneficiaries are being served.

2a.   Is this a New or Existing Project? (Check one:      New      Existing)
       If this is a new project, demonstrate how the proposed program will continue if it were
          only funded for one year.

          If this is an existing project, please state past achievements attained and include actual
           numbers achieved. (If you are a CDBG sub recipient for FY 2010-11, report your
           number of persons served at the time of application).

          If this is not an ongoing service, state how long it will take to complete the project.
      3/2011v.                                                                                          2
3.   Need Justification:
     Describe why the project is needed in the community and why CDBG funds, specifically, are
     needed to support the project.

4.   Benefit to Low to Moderate Income Clientele:
     Agency must insure that unduplicated persons or households benefiting from the grant are
     low and moderate income. This information will be used to measure the project’s
     performance outcome.

     Part I. Describe the clientele you intend to serve.
         If there is a target clientele population served by the agency, explain how the
             population is selected, qualified and monitored.
         Explain how you currently conduct marketing and outreach to the cultural, minority or
             hard-to reach component of your target population.
         Will there be any outreach changes in FY 2011-12? Describe the process of
             collecting unduplicated data for persons or households, including staff contact that
             will collect program and data.
         Are there other programs in the community that address similar issues as that of
             your agency? If yes, how is your proposal different?
         Explain in detail what documentation your agency collects to determine income
             status (i.e. pay stubs, tax forms, bank statements, sworn statements, etc.

     NOTE: Only count clientele within the period of October 1, 2010 to current period. *

                                            Clientele LMI Table

             Low to Moderate Income (LMI)                               Responses
             Total Number of Unduplicated Clients (Persons
             or Households) Agency served YTD Total in FY
             2010-11 *
             Total Number of Unduplicated McKinney
             Clients (Persons or Households) served YTD in
             FY 2010-11. *
             Percentage (%) Proportion of Agency’s Services
             provided only to McKinney clients
             Percentage of McKinney Clients considered
             Low to Moderate Income:

             Total number of McKinney Persons or               ____ of Persons or Households
             Households expected to be served under this       Served
             FY 2011 project? Also, select the percentage of
             LMI will the agency serve under the proposed      Select LMI Percentage:
             grant?                                            __ 0 to 30% of Median Income
                                                               __ 31-50% of Median Income
                                                               __ 51-80% of Median Income
                                                               __ Above 80% of Median
                                                               __ No Income Target

     3/2011v.                                                                                  3
     Part II.

               Explain the intake/application process for clientele, i.e. how do you register, enroll
                services for clientele?

               Will the program charge fees to participants?                    Yes       No
                (Fees must NOT exclude low/moderate income people)

               Will your clientele under HUD’s Presumed Benefit criteria?        Yes      No

                If yes, select group that the agency serves primarily or serves 100% of its clientele.

                           Abused Children
                           Abused Spouses
                           Elderly Persons (62+)
                           Severely Handicapped Persons
                           Homeless Persons
                           Illiterate Adults
                           Persons with AIDS
                           Migrant Farm Workers

4.   Agency Description:
     Briefly describe the mission and activities of the organization, and explain how the activities
     to be funded in the grant request fit in with other activities. Describe the experience of the
     organization in carrying out the type of activities proposed in this application and the length
     of time the organization has been involved in provided the proposed services. If the agency
     does not have prior experience in providing the proposed service, please indicate
     experience and successes in carrying out similar programs.

5.   Agency Accessibility:
     Please explain how accessible your agency’s location is to your clients. Are you
     geographically easy to reach? How do your clients get to your facility? What are your hours
     of operation? Are your facilities handicap-accessible? If your proposed activity will be
     conducted in locations away from your main facility, how will clients access the services?

6.   Work Schedule:
     Please provide a proposed schedule (include date and operation hours) for the use of grant
     funds and include the complete address where the activity will take place. Remember,
     regardless of location schedule and program must serve McKinney residents. If there are
     multiple locations for the activity, please state locations. The schedule should provide
     projected milestones and deadlines for accomplishment of tasks or the delivery of services.
     These projected milestones and deadlines are a basis for measuring actual progress during
     the term of the agreement. Include the names of all Program and Financial staff that will be
     responsible for carrying out compliance and reporting requirements.
     It is STRONGLY suggested all expenditures be completed by September 20, 2012 in
     time for reimbursement before the end of the funding cycle on September 30, 2012.
     The final work schedule will be incorporated into your subrecipient agreement.

     Is the proposed activity in operation year-round during the program year or seasonal?
           Year-round           Seasonal

      If seasonal, which months of the year will this program operate? _____
     3/2011v.                                                                                            4
 8.   Financial Review of Funds:

            When was the most recent A-133 audit or review of your financial records?

            State the total amount of federal funds (from all sources) received in current year,
             FY 2010-11 (Oct. 1, 2010 to Sept. 30, 2011)

            Does your agency expect to receive $500,000 or more (as a direct recipient or a sub-
             recipient) from all sources of federal funds in FY 2010-11? Yes  No

            If the answer is “Yes,” the agency is REQUIRED to please submit one copy of your
             Single Audit with the funding application.

            Who is responsible for maintaining the agency/organization’s financial records?
             (Name, phone number, position)

 9.   Volunteers:
      Will you utilize volunteers for the program for which your agency is requesting funds? If so,
      please describe how these volunteers will be utilized for the proposed activity and estimate
      the amount of volunteer time to be dedicated to the project.

10.   Partnerships:
      Describe any collaboration that is currently in place (or will be) for this project. List all
      agencies or organizations with which you are collaborating for your project. Also, list other
      collaborate efforts, if any and how you interact with these organizations or programs.

11.   Other:
      Provide any other information that may be pertinent to this application that was not stated in
      previous questions.

12.   Program Budget:
      Include the agency or organization’s operating budget for the current year. Next, please
      provide a detailed, line-item budget for the agency or organization’s program/project
      request, showing CDBG revenue, all other revenues and expenses. Include such things as
      whether or not equipment is purchased or rented, nature of contractual services to be
      performed, staff positions to be funded for project, etc.

      List as Program Budget as Exhibit A - 1 in attachments. The final program budget will be
      incorporated into the Statement of Work section of the agency’s contract with the City.
      If your agency serves COLLIN COUNTY or other counties, please submit the annual budget
      for the McKinney office ONLY, as it applies to the above instructions. If you do not have a
      McKinney office, indicate the portion of the budget that will be designated for McKinney.
      Include a list of current and planned fund-raising efforts.

      3/2011v.                                                                                        5
12a.   Funding Sources (Narrative and Chart):

       Narrative Questions.

       If CDBG funding is not granted, will the project go forward? What non-CDBG sources will
       fund the program? Will the project continue after the CDBG funds end; if yes, explain how
       funding will be provided, and describe any reduction in services that would result from the
       loss of CDBG funding?


       USE LEVERAGING OF OTHER FUNDS CHART to answer the following questions:
       List ALL efforts to obtain funding for this project from sources other than CDBG, including all
       pending or denied applications.

       If the agency received CDBG or any type City funding in FY 2009-10, please list each
       amount and funding type below.

       3/2011v.                                                                                      6
13.   Performance Measurement Standards
      Please use a separate numbered sheet to answer the following questions and attach the
      performance measurement table as last page of your attachments (see Tables 1 and 2):

      Part I.
          What results do you anticipate?
          Describe how the proposed project fits the needs of the population to be served, how the
              target population’s needs are assessed and the performance measures to be used to
              evaluate the success of the proposed project.
          Also include how often you plan to measure success/failure of the project.

      Part II.
      All approved applicants will be required to comply with the standards. This information is
      reported to HUD. The City of McKinney will monitor the performance of each agency both
      quarterly and annually. This includes the objectives and outcomes that best reflect what is to be
      achieved by funding the activity, within the City’s priorities of the Annual Action Plan and
      Consolidated Plan.

            Please select the best objective and outcome listed below for the proposed project.

      OBJECTIVES (Select One):
               Creating Suitable Living Environments
              These types of activities are designed to benefit low to moderate income persons by
              addressing issues in their living environment. Examples of public services under
              these criteria would include transportation projects, meal delivery, healthcare,
              education, etc.

                  Providing Decent, Safe, and Affordable Housing
                 Eligible activities would include rehabilitation or other housing projects that allow
                 affordability for lower income families and individuals. Examples include homeowner
                 rehabilitation, acquisition, new construction, homeowner assistance.

      OUTCOMES (Select One):

                  Affordability. Improving the provision of public services or housing
                 activities within the City of McKinney to make it more affordable to low to
                 moderate residents, such as transportation, affordable housing, and day

                 Performance Outputs to be determined may include:
                 o Numbers of low or moderate-income persons/households served
                 o Numbers of households/persons assisted with new access to a service;
                     or improved access to a service.
                 o Number of beds created in overnight shelter or other emergency

                    Availability or Accessibility. Activities that include the basics of daily
                 living will reflect availability/accessibility of public services or housing
                 activities, to low-moderate income families.

                 Performance Outputs to be determined may include:
                 o Number of low or moderate-income persons/households served
                 o Numbers of households/persons assisted with new access to a service;
                     or improved access to a service.
                 o Number of households assisted that received emergency financial
                     assistance, or emergency legal assistance to prevent homelessness

      3/2011v.                                                                                            7
Documents to Be Submitted in the Following Order:

A. Summary Page

B. Application

C. Budget (Organization and Program Budget as Exhibit A1)

D. Fund Leveraging Chart 12a

E. Performance Measurement Tables for Proposed Project (Tables 1 and 2)

F. Resumes of Executive Director, Project Director and Financial Officer.

G. List of Officers and Members of the Board of Directors – Must include the name,
   telephone number, address, occupation or affiliation of each member and must
   identify the principal officers of the governing body.

H. A copy of the agency’s IRS Letter of Determination certifying tax-exempt status.

I.   A current copy of the agency’s Certificate of Good Standing from the State
     Comptroller’s Office. To obtain this document, go to and search by Tax ID or
     Company Name. At the next screen, click on the organization name, and then click
     on Certificate of Account Status. ** If the organization name is now different from the
     name registered with the Comptroller’s Office, please register the correct name with
     them. The name on the Certificate should be the name on your application. If you
     are not in good standing with the State, you will be required to take whatever
     correction action necessary before a funding contract is executed.

J. Proof of Liability Insurance. A copy of the agency’s current ACORD Certificate of
   Liability Insurance. Note: The agency must carry liability insurance in the amounts
   outlined in grant section entitled INSURANCE REQUIREMENTS.). This is required
   again prior to the award of the grant agreement with the correct certificate holder

K. Include one (1) copy of the most recent audit of the organization’s financial records
   with the audit management letter attached. (Include the original audit with the original
   packet and make copies of the audit to submit with the other 8 application copies).

L. Conflict of Interest Questionnaire

3/2011v.                                                                                       8
                                             CDBG FY 2011-12
                                         FUND LEVERAGING CHART
                                               (Question 12a)

Project/Program Name:

        List sources, including funding amounts, to which you have committed funding
         or expect renewal of funding for the proposed project/program.
        List new funding resources, including the anticipated funding amounts, to which your
         agency/organization plans to apply for funding for the fiscal year and have high
         expectation of being funded for the proposed project/program.

         FUNDING SOURCE                                        AMOUNT ($)                USES
(include City and other govt. entities, if applicable)



(include City and other govt. entities, if applicable)


LOCAL                                                      $
FEDERAL                                                    $
STATE                                                      $
                     Note: This will be a part of annual compliance reporting for City and HUD.

3/2011v.                                                                                          9
                                CITY OF MCKINNEY

Please complete, sign and date. Questionnaire MUST BE included with application.

The Agency agrees to abide by the provisions of 24 CFR 570.611 with respect to conflict of
interest and covenants that it presently has no financial interest and shall not require any
financial interest, direct or indirect, which would conflict in any manner or degree with the
performance of services required under those CDBG program regulations. The Agency
further covenants that in the performance of receiving CDBG funding, no person having
such a financial interest shall be employed by the Agency hereunder. These conflict of
interest provisions apply to any persona who is an employee, agent, consultant, officer or
elected official of the City of McKinney, or of any designated public agencies or
subrecipients, which are receiving CDBG funds.

 1.      Is there any member of the applicant’s staff, member of the applicant’s Board of
         Directors or officer who currently is or has been within one year of the date of this
         application a member of City Council or a City employee?

         ____ Yes
         ____ No
         If yes, please list name(s):

      2. Will the funds requested by the applicant be used to pay the salaries of any of the
         applicant’s staff or award a subcontract to any individual who is or has been one year
         of the date of this application a member of City Council or a City employee?

         _____ No
         If yes, please list name (s):

      3. Is there any member of the applicant’s staff, member(s) of the Board of Directors, or
         officer(s) who are business partners or immediate family of a City Council member or
         a City employee?
         _____ Yes
         If yes, please list name(s):

The applicant certifies to the best of his/her knowledge and belief that the data in this
application is true and correct and that the filing of the application has been duly authorized
by the governing body of the applicant and that the applicant will comply with all of the
requirements of the grant if the application is approved.




3/2011v.                                                                                    10
                                                     FY 2011-12 CDBG Funding Application
                                                      Table # 1: Performance Measurement



           Program                     What                             How
                                                                                                                               Cost to Deliver
                                                                                            How will you measure
     Identify by name      Provide a brief description of    Describe in what fashion       These are the outcomes that will   Indicate how much it will cost
     the program for       the program. Are you providing    your program will be carried   help you determine how             to deliver the proposed
     which you are         training? One-to-one              out. What kinds of services    successful the program is.         program. How much of this is
     seeking CDBG          counseling? Direct services?      or activities are provided?    Identify what you are trying to    CDBG and how much is from
     investment. Place     This should relate to Part I of   Transportation, classes,       achieve with your program and      other sources?
     only one program in   this application.                 counseling, support groups,    tell us how you will measure it.
     a box.                                                  etc? How many clients          You must have at least one          Please see Table # 2 to
                                                             served? What is covered in     measure per activity.              arrive at the cost to deliver
                                                             the sessions? What is the                                         the program.
                                                             curriculum? Etc.

3/2011v.                                                                                                                                                        11
                                             FY 2011-12 CDBG FUNDING APPLICATION
                                                 PERFORMANCE MEASUREMENT
                                                      Table # 2: Delivery Cost

   For each program listed in Table # 1, show how costs are determined:
   What does it cost to put on a program and how did you arrive at that cost?
   Costs must relate to overall costs to deliver the program.

   Complete this Table Program:
   Agency Name:

           Cost Elements                                   Cost ($)             Quantity/Unit of measure


3/2011v.                                                                                                              12

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